Provider Demographics
NPI:1396945382
Name:DESANTIS, MAUREEN M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:M
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:M
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:401 OLD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1538
Mailing Address - Country:US
Mailing Address - Phone:732-528-2230
Mailing Address - Fax:
Practice Address - Street 1:1617 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-5106
Practice Address - Country:US
Practice Address - Phone:732-701-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052521001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical